Why Brett Kavanaugh Matters to Birthing Women in the UK

Photo of Brett Kavanaugh looking angry.

Guest Post by Emma Ashworth

Permission has been freely given by “Sarah” to include her experience in this article.

For those who are not following politics in the USA, there’s one of those slow car-crash moments happening which could have a huge and profound effect on the culture and law around women’s bodies not only across the pond, but here also in the UK and Europe.

Brett Kavanaugh is an American judge who President Trump wants to promote to fill one of only 9 positions on the US Supreme Court. These positions are life long, and filling a Supreme Court position is how Presidents leave a legacy which could last for many decades. Bizarrely, although judges are expected to be impartial, these judges are chosen very much on their partisan opinions, and Kavanaugh has shown over the years that he does not support women’s reproductive rights.

The process to finalise Kavanaugh’s escalation to the highest court in the United States hit a last minute bump in what had previously been a very smooth road when a woman called Christine Blasey Ford made an accusation that when she and Kavanaugh were both teenagers – he 17, she 15 – he attempted to rape her and held his hand over her mouth in such a way that she feared that he would kill her. Subsequently two more women have come forward to accuse Kavanaugh of serious charges of sexual abuse. In a climate where the US President has been accused of sexual assault and rape by at least 22 women (whom he has called liars), and has himself boasted that he can “grab them by the pussy”, the climate for women who confront those who assault them is unrelentingly hostile. The Republican senators have almost unanimously closed ranks around their frat boy, protecting their own and perhaps also themselves… if one of them can be accused, why not all?

While Dr Blasey Ford goes through a partisan process where she is systematically ripped apart (who helps to put her back together again?), where Trump mocks her testimony to a crowd of cheering men AND women and the media is undertaking a trial-by-opinion, underneath it all is the same relentless, persistent, ruthless misogyny which underlines the way that women are treated following all forms of assault, including obstetric assaults.

While watching and reading about Kavanaugh I was reminded of a senior midwife who once berated me for supporting a woman who was, in her opinion, “just out to get” the midwife that she was making a complaint about. The birthing woman, let’s call her Sarah, had never met the midwife before she came to her in labour. Sarah had no personal reason to be “out to get” this midwife outside of the assault that Sarah explains happened to her during her birth. Sarah went through the complaints process with the hospital and, like most women who complain, was told all the reasons why she was wrong about what happened to her. Like the Republican senators, the Trust closed ranks and rejected Sarah’s complaint with a combination of rebuffs right out of the rape defence textbook, including lack of evidence, arguing that she must be wrong or have misunderstood, and attacking Sarah herself as being aggressive and abusive, as though trying to escape from what Sarah experienced as a desperately dangerous situation was unreasonable behaviour.

Sarah’s experience is not at all unusual. Like Kavanaugh’s snarling, angry attacks on those who were trying to untangle the complexity of a sexual assault allegation, the shocking concept that a woman could deign to raise her head to say “you hurt me” to those who are actually supposed to care leads to aggressive denials from both trusts and health care providers who fight back with arguments about “policy” or “guidelines” but who actually mean “we know better than you, how dare you question our power”.

The satirical news site “News Thump” put it brilliantly with their headline, “Man ridiculing victim of sexual abuse on world stage asks ‘why didn’t she come forward sooner?’ We could just as easily say “HCPs telling women they’re wrong about their birth experiences ask why women don’t make complaints about obstetric violence”.

I do see a light, though, and it’s a light made up of flames. I see women who are no longer willing to stay silent, and for every woman who speaks out either to her peers or in a complaint she lights a flame. AIMS reminds us that “It is better to light a single candle than to curse the darkness” and every flame that is lit shows the way for another, and another, and another. We will not be silenced and we will no longer be forced to be in the dark. Our flames are growing and our flames are joining. We are all the granddaughters of the witches that they did not burn, we are not going away and we are SHOUTING.

#metoo

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If you have experienced obstetric violence, or a birth which included an assault and would like help or support, you can contact the AIMS Helpline here.

York Homebirth Midwives: between a rock and a hard place (and women crushed in the middle)

Guest blog by Emma Ashworth

“If you arrive at the home of a woman and she refuses to allow you to access her home or to provide care to her, you must explain that you will need to leave and explain this decision to her. You should inform the woman that you will be happy to return to provide care should she want you to do so. The conversation should be fully documented.”

York Teaching Hospital NHS Foundation Trust: Home Birth Guideline Version No: 9, August 2017 – August 2020. Page 7

This quote from the York homebirth guidelines could lead to catastrophe.

While the senior midwives at York have said that they are reacting to a situation where they were not permitted in the house, the worrying phrase is this, “[the woman] refuses to allow you… to provide care to her”.

Women have been told that if they decline blood pressure monitoring, or intermittent monitoring, or even vaginal exams that their midwife “has been told that she must” leave their house and abandon them without care. Midwives have argued that if the mother doesn’t want to have interventions or tests, why should they even be there? What is their purpose? The knitting midwife expectantly and watchfully waiting in the corner, only intervening when necessary, does not seem to be the type of midwifery that York Trust is aiming for despite the fact that this type of midwifery leads to the best outcomes as is seen by the results of independent midwives.

Women have reported that midwives have coerced them into vaginal exams that they didn’t want with the threat of leaving them to birth alone. They have had to make the decision to allow someone to penetrate their vagina when they didn’t want them to, or to be left without clinical care for themselves or their babies.

In a discussion with one of the senior midwives at York Trust, I was assured that the threats that women were experiencing were not the intention of the policy, and that recently midwives had stayed with women despite the women declining certain interventions. I was also assured that the midwife that I spoke to would take my feedback to the community and home birth midwives to ensure that there was clarity in the guideline. She also confirmed that the guideline was in the process of review, so perhaps the very clearly written text in the current guideline saying that women in their own home are not permitted to refuse to have someone’s fingers inside them if they want a midwife to stay will be removed. However, despite my attempts to follow up this with the Trust, to date (7th August) I have not received a response to my initial or follow up requests.

In the meantime, Birthrights and AIMS have worked together on this issue, leading to an information sheet for women and midwives who might find themselves in this situation.

There are some really key points here that the Trust and its midwives need to consider about these guidelines. Midwives are under an obligation to act within the law, and coercing women into interventions is illegal. While the Trust may argue that there is no point in the midwife being there if the woman doesn’t want to have some clinical checks, we need to remember that women can decline any or all interventions at any time – and that a midwife’s role is far more than vaginal exams and listening in to a baby’s heartbeat. There is huge value in her being there, offering her support and knowledge and if necessary being able to intervene clinically. The Trust’s argument that there’s no point in the midwife being there belies the fact that skilled midwifery is in stepping in when needed, not about taking blood pressure. We need to remember that many of these interventions are not necessarily helpful, and can be harmful in some situations (and can also be very useful in others).

The AIMS information sheets on vaginal exams discusses some of the pros and cons of routine vaginal exams. Their sheet on monitoring in labour explains some of the risks and benefits of intermittent and continuous monitoring. If a woman wants to decline auscultation now, she can accept it for her next contraction, or decline it again. If a midwife forces her into a check on the threat of abandoning her, the stress of that on the woman may itself severely impact on her labour, and could cause damage to her or her baby, and the midwife is legally responsible for this. A midwife who undertakes an intrusive examination after obtaining consent through coercion needs to know that she is committing an assault on that woman, and that she could be criminally charged. Part 1.5 of the Nursing and Midwifery Code states that midwives must “Respect and uphold people’s human rights.” And 2.5 says, “respect, support and document a person’s right to accept or refuse care and treatment” 17.1 of the Code states that midwives must, “take all reasonable steps to protect people who are vulnerable or at risk from harm, neglect or abuse.” And yet, this guideline is instructing midwives that they must either neglect a woman, who while she is in labour she is by definition vulnerable (by leaving), or abuse them (by committing assault).  At the same time, if the midwife refuses to follow the guideline and stays with a woman who declines some or all interventions or checks during her labour, she is at risk of being disciplined by the Trust. And if she leaves, she and the Trust are likely to be liable for any adverse outcomes to mum or baby!

If women find themselves in the situation where they are being coerced in their own home, I would advise that they remind the midwife of her obligations under the NMC code and the law. Showing the midwife the Birthrights document could be enough to encourage the midwife to break out of the intolerable situation that she’s been forced into by this unfair and unreasonable Trust document. Know that what is being asked of you in your labour is not reasonable, it is not normal practice and it is not something you need to say yes to.

Midwives – rise up! You are autonomous practitioners and you cannot accept the risks to your own safety and practice that this guideline traps you in. You need to escape because no matter which way you choose you are exposing yourself to risk. Be part of the fight to change this guideline! Stay with women and request support from senior midwives (who have assured me that they will give it).  Don’t let this happen to you and to the women you’re caring for!